First, the insurance part. We are legally obligated here to have health insurance. Insurance companies here MUST offer the ‘basic policy’ for around 89 euros a person. Certain things are required to be in this policy and some insurance companies throw in little extras because our insurance industry is still competitive. After you have the basics covered (doctor visits, hospital, certain meds, and so on), you can pick extras. Like vision, dental, extra psych. I’d have to look at our policy to see what the entire list of extras is. These extras, of course, add to your policy and you can pick them for one member of your family or the whole family. Insurance companies are not allowed to refuse ANYONE from the basic policy and they can’t raise the premiums based on pre-existing conditions. (That’s the part I really really like)
This year, they introduced a 150 euro, per person, per year deductible. I think I was the only person in our circle not complaining. Compared to the US, that’s peanuts. For families below the median income, they get a refund on a monthly basis from the tax office.
Now onto how our doctors works. You have to sign up with a ‘huisarts’ or GP. Earlier, it wasn’t possible to switch, but that’s changed. I don’t particularly like my GP, but since she’s part of a practice, I can usually avoid her and I only need my GP like once a year. There is no co-pay thing at the time of service and doctor visits are 100% covered, and not part of the deductible.
Most GPs have certain hours during the day that you can call to make an appointment. This doesn’t count for emergencies, however. In order to see a specialist, you have to have a referral from your GP. In your case, you would get a referral to a OB/GYN because you’re a high risk pregnancy. Our GPs handle a lot more than US GPs as well. Birth control, and pap smears are done in their office. I personally like this policy because it saves the specialists time for people that REALLY needs them and they aren’t wasting their time on Crazy Aunty Grizelda the professional hypochondriac.
When you get your appointment, you’re not collected by a nurse to sit in the exam room for 30 minutes until the doctor breezes by for a 5 minute chat. The doctor comes to get you and usually takes you back to their office/exam room. If it’s a referral, they print out the letter, sign it and you’re on your way. Otherwise, it’s just like home. They aren’t pill happy here and sometimes you have to almost argue with the older ones. But that’s more a Dutch culture/Calvinistic/pain is for the weak thing. They don’t have as many nurses in the office as we have in the US, either. And the only time I’m NOT seen by the doctor is when I get my pap smear.
So, how does this all manage to work? How is it that our medical costs are lower, our insurance is cheaper and we get the same level if not better medical care in the US?
First of all, insurance/litigation payments are set by law. If you’re injured and have to sue, you’re NOT going to get millions of dollars. If the injury disables you, you’ll get a payment based on your age, what salary you would have brought home until you retired, and the level of your disability. They also aren’t big on pain/suffering payments. Once again, it’s that Dutch/Calvinistic/pain is for sissies thing. Dutchies are strange little people but I love them dearly. That means our GPs have seriously low malpractice insurance premiums, which translates into lower running costs for their offices.
Second, our GPs get a lump sum payment from the govt. each year based on the number of patients their practice has. Since this comes from my tax dollars, I look it like a retainer fee you would pay a lawyer. It also means that my GP isn’t trying to cram patients in like sardines. Their education costs are lower as well. Yes, they student loans to pay off but it’s nowhere near the amount that US doctors have.
So…….in order to bring health care costs to a reasonable level in the US, there has be a lot of reform. They have to work on the legal system to stop these multi-million dollar payouts. Once those payouts are set at a more reasonable level, then they need to work on the insurance companies. As I said, we’re a country of about 16 million people. Kids are covered at no cost to the parents. We probably have as many insurance companies here as there are in the US. But they almost always make a profit. Our insurance company is a cooperative/non-profit deal. So any profit is shared with the policy holders. That 9 euro profit share we got excited me so much, I went out and bought sock yarn. *grin* We also have our home/renters insurance with them and it’s dirt cheap for a lot of coverage.
The US also needs to work on it’s higher education system. How many brilliant teenagers are stuck working in blue collar jobs because they couldn’t afford college? But that is a rant for another day.
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